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1 Social Support Lijun Song Vanderbilt University Joonmo Son Social Support Lijun Song Vanderbilt University Joonmo Son National University of Singapore Nan Lin Duke University Key words: Social support, social network, social integration, social capital, social cohesion Song, Lijun, Joonmo Son, and Nan Lin. 2011. “Social Support.” Pp. 116-128 in The Sage Handbook of Social Network Analysis, edited by John Scott and Peter J. Carrington. London: SAGE. 1 Social support, a network-based social phenomenon, has become the focus of research attention in the last three decades. As shown by a search of the Social Sciences Citation Index for articles whose topic includes “social support” there were only three such articles in the 1950s and ten in the 1960s. The number rose to seventy-six in the 1970s. Following this, on average per year, there were ninety-four such articles in the 1980s, 1394 in the 1990s and 2687 from 2000 to 2008. Social support has attracted burgeoning attention especially in health literature since the lack of social support is regarded as a potential fundamental cause of disease (Link and Phelan, 1995). As another search of the Social Sciences Citation Index for articles with “social support” and “health” in their topics reports (see Figure 1), on average per year, there were less than six such articles from 1976 to 1989; the number increased to 445 in the 1990s and dramatically jumped to 1135 from 2000 to 2008. A few books explored the relationship between social support and its health consequences (Caplan, 1974; Caplan and Killilea, 1976; Cohen, and Syme, 1985; Cohen, Underwood, and Gottlieb, 2000; Gottlieb, 1981 1983; House, 1981; Lin, Dean, and Ensel, 1986). Many reviews from different disciplinary backgrounds have surveyed the associations of social support with various health-related outcomes (Alcalay, 1983; Berkman, 1984, 2000; Coyne and Downey, 1991; Ell, 1984; Faber and Wasserman, 2002; Green, 1993; House, 1987; House, Umberson, and Landis, 1988; Kessler, Price, and Wortman, 1985; Schwarzer and Leppin, 1991; Smith et al., 1994; Thoits, 1995; Turner and Turner, 1999). 2 1800 1600 1400 1200 1000 Publications of 800 600 400 Number 200 0 Year of Publication Figure 1 Articles with “Social Support” and “Health” in topic: Social Sciences Citation Index Despite its substantial popularity and voluminous development, the term of social support still stimulates debates on its conceptualization and operationalization. Social support is confounded with other network-based but distinct social factors without clear discrimination, such as social cohesion, social integration, social networks, and social capital. Empirical results on its health returns are abundant but inconsistent across studies. We thus begin this review by clarifying the nature and forms of social support. We then turn to its distinction from and association with other network-based factors. Next, we examine the operation of social support in the social production process of disease and illness. We conclude with a brief discussion of future research directions of social support research. Even though social support is a sociological phenomenon in nature, the existing literature on the topic has been dominated by epidemiologists, psychiatrists, and 3 psychologists, as House et al. (1988) observed two decades ago. Sociologists are expected to play a crucial role in the advancement of future studies on social support. CONCEPT OF SOCIAL SUPPORT: NATURE AND FORMS The idea of social support has achieved great currency since the middle 1970s (for reviews see Barrera, 1981, 1986; Cohen, Gottlieb, and Underwood, 2000; Dean and Lin, 1977; Gottlieb 1981; Lin, 1986a; Thoits, 1982). Epidemiologist John Cassel, physician and epidemiologist Sidney Cobb, and psychiatrist Gerald Caplan made groundbreaking contributions to its popularity. Cassel and Cobb summarized accumulating empirical evidence on the promising impact of relational factors in health maintenance and promotion, and underscored social support as one such protective antecedent. Cassel (1974, 1976) dichotomizes various social conditions relevant to health from a functionalist perspective: one category protects health, while the other one produces disease. He speaks broadly of social support as the first category, “the protective factors buffering or cushioning the individual from the physiologic or psychological consequences of exposure to the stressor situation” (1976: 113). Cobb (1974, 1976) uses a communication perspective. He (1976) conceives of social support as information, and classifies three types of information in terms of their functions: information leading a person to believe that he or she is cared for and loved (i.e., emotional support), is esteemed and valued (i.e., esteem support), and belongs to a network of communication and mutual obligation. Similar to Cassel’s definition, Cobb argues that the major protective role of social support lies in its moderating effect on life stress instead of its main health effect. In addition, psychiatrist Gerald Caplan (1974: 6-7) addresses the 4 concept of the support system as “an enduring pattern of continuous or intermittent ties that play a significant part in maintaining the psychological and physical integrity of the individual over time”, and lists three types of support activities: “The significant others help the individual mobilize his psychological resources and master his emotional burdens; they share his tasks; and they provide him with extra supplies of money, materials, tools, skills, and cognitive guidance to improve his handling of his situation.” More attempts to conceptualize the substance of social support from different perspectives quickly followed. Dean and Lin (1977) consider social support as functions of primary groups that meet instrumental and expressive needs. Lin and colleagues later reconstruct social support at multiple levels of social networks as “support accessible to an individual through social ties to other individuals, groups, and the larger community” (Lin et al., 1979: 109). Kaplan and colleagues (Kaplan, Cassel, and Gore, 1977: 54) point out that social support is the content of social ties (i.e., “the meanings that persons in the network give their relationships”), and is contingent on structural and interactional characteristics of social networks (i.e., anchorage, reachability, density, range, directedness, intensity, and frequency). Henderson (1977) applies attachment theory, and views social support as affectively positive social interaction with others under stressful conditions. Gottlieb (1978) lists four forms of informal social support derived from twenty-six helping behaviors: emotionally sustaining behaviors, problem-solving behaviors, indirect personal influence, and environmental actions. Wellman (1981) dichotomizes the content of social ties. He asserts that social support is only one type of content; the other is nonsupport. He lists five forms of social support derived from 5 twenty-one interactional strands: doing things, giving and lending things, help with personal problems, information help, and shared activities, values, interests, and interaction. He also highlights the variation of social support with network properties (i.e., ties strength, tie symmetry, density). Pearlin and colleagues view social support as “the access to and use of individuals, groups, or organizations in dealing with life’s vicissitudes” (Pearlin et al., 1981: 340). House and his colleagues define social support as one type of relational content, “the emotionally or instrumentally sustaining quality of social relationships” (House et al., 1988: 293). Berkman (1984) sees social support as the emotional, instrumental, and financial aid that is obtained form one’s social network. More recently, Turner (1999) defines social support as social bonds, social integration, and primary group relations. Cohen and colleagues refer to social support as “any process through which social relationships might promote health and well-being” (Cohen et al., 2000:4). These different conceptualizations reflect an ambiguous construction of the social support concept. Despite the inconsistent framing, most of these efforts explicitly or implicitly converge on the relationship-based, assisting nature of social support. Based on the above review, we are more attracted to a strict synthetic definition of social support as the aid— the supply of tangible or intangible resources—individuals gain from their network members (Berkman, 1984; House, 1981). This definition narrows down social support to a specific relational content, separates its nature from its preceding social structures such as social networks and social integration, and eliminates its tautological assumption that social support protects against disease and what fosters health is social support. The 6 stretching of social support as general environmental factors (Cassel, 1976), relational content (Kaplan et al., 1977; Henderson, 1977), or relational process (Cohen et al., 2000) paves the way for diverse measurements and mixed evidence, and endangers the unique theoretical value of social support. The functionalist framing of social support (Cassel, 1976; Cohen et al., 2000; Henderson, 1977) mixes social support with its consequences, and overlooks the fact that social support does not always function in a positive direction to meet needs, or to intervene between stressors and health. The disease- or stress-related definition (Cassel, 1976; Cobb, 1976; Cohen et al., 2000; Henderson, 1977; Pearlin et al., 1981) constrains the significance
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